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County-Wide Collaboration the Key to REACH Grant
The PRCHN is proud to be involved in two of the three Racial and Ethnic Approaches to Community Health (REACH) grants from the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS) awarded in the Greater Cleveland area. REACH grant awardees are charged with targeting poor nutrition, physical inactivity, and improving linkages to quality health services. REACH grants are targeted to population clusters where 30% of the population is living in poverty and more than 25% of adults aged 25 and older do not have a high school education.

How HIP-Cuyahoga Led to REACH
The PRCHN works with a number of community partners, but perhaps its largest collaboration is as part of Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga), a consortium whose membership features more than 50 diverse organizations. This partnership was formed to identify community, social, and health priorities and, based on those priorities, create strategies to improve health in Cuyahoga County. It was originally convened by the three health departments in Cuyahoga County, the Cuyahoga County Board of Health, Cleveland Department of Public Health, and Shaker Heights Health Department.

The PRCHN has played an active role in HIP-Cuyahoga’s work since its inception and is a sub-grantee on the three-year REACH grant. The Cuyahoga County Board of Health is the main grantee. Other sub-grantees along with the PRCHN include Better Health Partnership, OSU Extension-Cuyahoga, Fairhill Partners, Neighborhood Leadership Institute, Tremont West Development Corporation, and Strategic Solution Partners. In addition, all other organizational partners of HIP-C also support this work. The PRCHN has two roles in the HIP-Cuyahoga REACH grant: (1) PRCHN Associate Director Dr. Erika Trapl is leading development and implementation of the Healthy Eating and Active Living strategies; and (2) PRCHN Director Dr. Elaine Borawski is the External Evaluation Lead.

In addition, the YMCA of Greater Cleveland also received REACH grant to create clinical and community linkages and encourage healthy eating and active living in target neighborhoods within the city of Cleveland. The PRCHN will conduct internal and external evaluations of portions of the YMCA grant. The combined reach of these two awards will cover a large portion of the priority census tracts in the city of Cleveland (see map).

Components of the HIP-Cuyahoga REACH Grant
Community engagement is a cornerstone of HIP-Cuyahoga’s approach and features prominently in the HIP-Cuyahoga REACH project. The project is being implemented in 22 census tracts within the cities of Cleveland and East Cleveland. The REACH project has several aims:
• Engage residents to improve access to healthy foods
• Increase opportunities for physical activity
• Improve hypertension management
• Facilitate linkages between health clinics and community resources

The HIP-Cuyahoga Healthy Eating and Active Living (HEAL) Sub-committee, anchored by the PRCHN, contributed to the identification of the strategies to be implemented through the REACH grant. This group identified a Healthy Corner Store initiative as a key approach to increasing access to healthy foods, especially in neighborhoods where there aren’t any supermarkets.

The first step is engagement—asking residents to identify stores where they think they’d shop. Many convenience/corner stores don’t often sell fruits, vegetables, or other healthy items, such as whole grains. Residents will nominate stores in their neighborhood where they feel there is an opportunity to add additional fruits and vegetables. Residents will also suggest other healthy food items. REACH grant staff might also look at how food is arranged in the store to ensure that fruits and vegetables are prominently displayed and tobacco products are less prominent. They will also offer social media and other marketing ideas to help store owners identify themselves as healthy stores. Dr. Trapl and REACH Strategy Coordinator Kakul Joshi hope that the Healthy Corner Store initiative will be rolled out within the next six months.

The Food Trust, a Philadelphia-based nonprofit dedicated to increasing access to healthy food, visited the PRCHN and REACH partners in December 2014. The Food Trust has created a vibrant healthy corner store program in Philadelphia that includes nearly 600 stores. They are a national technical assistance provider for all REACH grantees and will be working with the HIP-Cuyahoga HEAL Sub-Committee and REACH team on the Healthy Corner Store initiative.

One approach to increasing opportunities for physical activity in low-resource communities is through the implementation of shared use agreements. Institutions with large space for activity offer to make that space available to other organizations and the broader community to host different types of programs. Schools are consistent shared use site partners, and the Cleveland Municipal School District has a shared use policy in place. The PRCHN and HIP-Cuyahoga REACH will host a shared use training on September 17, 2015. They will be joined by ChangeLab Solutions, which will facilitate a comprehensive training for organizations and other partners that may be interested in developing or implementing a shared use policy or delivering programming in a shared use site.

The REACH grant will work to improving hypertension management through both self-management and provider managed care. Better Health Partnership of Greater Cleveland is employing a hypertension best practice model for managing hypertension in a clinical setting. Better Health Cleveland has a two-fold goal:
1. Increase the number of clinics implementing HTN best practice in priority census tracts
2. Improve access to high-quality culturally competent care to priority census tracts

HIP-Cuyahoga REACH staff, specifically Fairhill Partners, will work toward improving hypertension self-management by training residents from the REACH census tracts in chronic disease self-management programs. This training will allow residents of the community to help their neighbors by leading workshops in their own neighborhoods.

Residents will also receive assistant in managing chronic health problems through the REACH’s efforts to facilitate linkages between health clinics and community resources. The REACH grant partners are currently finalizing the Produce Prescription Program for Hypertension (PRxHTN), which provides a “prescription” for fruit and vegetables as well as a voucher for produce to be redeemed at participating local farmers’ markets. Dr. Trapl and the PRCHN collaborated with CCBH and OSU-E on a Produce Prescription Program that provided pregnant women and their families produce prescriptions to farmers’ markets along with recipes and other support to encourage increased fruit and vegetable consumption. That program lays the groundwork for the PRxHTN program of the REACH grant, which will be rolled out jointly with Better Health Partnership and their partner health clinics to target patients with elevated blood pressure.

Dr. Trapl emphasizes the collaborative nature of the REACH grant. “This is not any one organization, it’s the work of a collaborative,” she says. “Without a collaborative effort to creating application and implementing the grant, we would not be as successful. It isn’t what any one person or group does but how we all do these things together.”

Components of the YMCA of Greater Cleveland REACH Grant
The PRCHN will conduct internal and external evaluation of the three major interventions of the YMCA’s REACH grant. The first of these inventions focuses on clinic-community linkages that seek to connect federally qualified health centers (in this case, Neighborhood Family Practice) with the YMCA’s Diabetes Prevention Program and Body Age Screening program. Both of these chronic disease prevention programs are robust one-year interventions that are undertaken voluntarily before an official diagnosis is made.

The second component seeks to increase the number of safe bike paths or bike lanes within the city of Cleveland to 70 miles by 2017. They will do this by creating bike advisory committees made up of residents in priority neighborhood populations. These committees will form recommendations that will be passed on to the city as it rolls out its increased bike facilities program.

The third component is an evaluation of parental engagement in the YMCA’s We Run This City program. This evaluation will look at this program through a unique lens: examining how parents do or do not become involved in healthy eating and active living through their children’s involvement in the program.

Collaborators for this grant include, but are not limited to: Neighborhood Family Practice, Kent State University, University of Toledo, and Cleveland Urban Design Collaborative.

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